Janeway Gastrostomy for Trans-gastric ERCP: an Emergency Alternative Method to Access the Excluded Structures

Excerpt

The incidence of gallstone formation after bariatric surgery is higher than that in the overall population due to the rapid weight loss and altered gallbladder [1]. If this occurs, the history of the bariatric procedure with the Roux-en-Y anatomic configuration, which alters the normal foregut and midgut anatomy, makes the management of stone pathology challenging in this group of patients. New purely endoscopic techniques such as single (SBE-ERCP) [2] or double-balloon enteroscopy-assisted ERCP (DBEA-ERCP) [3] and spiral enteroscopy (SEA-ERCP) [4] allow deeper access to the small intestine. Nevertheless, many difficulties may be encountered including maneuvering through gastrointestinal anastomosis and identifying and gaining access to the ampulla. Besides, these procedures are not recommended if the length of the Roux limb is ≥ 150 cm [5]. …